RESEARCH - Misdiagnosis of lupus

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Arch Intern Med. 2004 Dec 13-27;164(22):2435-41.

Diagnostic accuracy for lupus and other systemic autoimmune diseases in the

community setting.

Division of Rheumatology & Clinical Immunology and Center for Autoimmune

Disease, Program in Epidemiology & Public Health, and Department of

Biostatistics, University of Florida, Gainesville, USA. sonali15@...

BACKGROUND: Most individuals with autoimmune and other immune disorders

undergo initial evaluation in the community setting. Since misdiagnosis of

systemic autoimmune diseases can have serious consequences, we evaluated

community physicians' accuracy in diagnosing autoimmune diseases and the

consequences of misdiagnosis. METHODS: We studied the patients referred to

our Autoimmune Disease Center for 13 months (n = 476). We estimated the

degree of agreement with the final diagnosis (kappa statistic) and the

accuracy indexes (sensitivity, specificity, and predictive values) of the

referring physicians' diagnoses. RESULTS: We found a 49% agreement between

the referring and final diagnoses (kappa = 0.36). Of 263 patients referred

with a presumptive diagnosis of systemic lupus erythematosus (SLE), 125

received a diagnosis of other conditions (kappa = 0.34). Of those referred

with SLE, 76 (29%) were seropositive for antinuclear antibodies but did not

have autoimmune disease. The degree of agreement for referring

rheumatologists (kappa = 0.55) was better than that for nonrheumatologists

(kappa = 0.32). Stepwise logistic regression indicated that rheumatologists

were 4 times more likely to make an accurate diagnosis of SLE than were

nonrheumatologists (P<.003). Thirty-nine patients who were seropositive for

antinuclear antibodies but had no autoimmune disease had been treated with

corticosteroids at dosages as high as 60 mg/d.

CONCLUSIONS: Many patients with a positive antinuclear antibody test are

incorrectly given a diagnosis of SLE and sometimes treated with toxic

medications. The data support the importance of continuing medical education

for community physicians in screening for autoimmune diseases and

identifying patients who may benefit from early referral to a specialist.

PMID: 15596633

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=15596633

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Mayo Clinic in Rochester

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s Hopkins Medicine

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